Provider Demographics
NPI:1073723276
Name:OHIO STATE UNIVERSITY MEDICAL CENTER
Entity Type:Organization
Organization Name:OHIO STATE UNIVERSITY MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF PHYSICAL THERAPIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:FAYE
Authorized Official - Last Name:CONVERSE
Authorized Official - Suffix:
Authorized Official - Credentials:PT, ATC
Authorized Official - Phone:614-293-2385
Mailing Address - Street 1:173 MACDOUGALL LN
Mailing Address - Street 2:
Mailing Address - City:BLACKLICK
Mailing Address - State:OH
Mailing Address - Zip Code:43004-9317
Mailing Address - Country:US
Mailing Address - Phone:614-499-7100
Mailing Address - Fax:
Practice Address - Street 1:2050 KENNY RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-3502
Practice Address - Country:US
Practice Address - Phone:614-293-2385
Practice Address - Fax:614-293-3066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT09715261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy